Newby-need help -old condo

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Chippy

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Hi,

Trying to get the proper dosage for my cat Schmitty...9 years old, on Lantus, feeding FF

Started with 2cc, got glucose curve at vet and it was all over the place, brought Schmitty home and bought home tester.
Results were:

AMPS. 343
+2. 339
+4. 240
+6. 175
+8. 235
+10. 277
PPMS. 276
+14. 254
Next day

PAM'S. 278
PPMS. 182

Showed these results to my vet and he said increase dose by a quarter or half( he has been on insulin for about 4 weeks)

Started at 2.25 and first 2 days pre-shot values were in mid to low 200's, On third day my husband gave shot and gave 2.5. When I got home I did a +6 and level was 40, then +12 was 32(did not shoot) + 15 was 48. Below is next few days....

Date. AMPS. . Shot. PPMS. Shot

5/26. 100. >.50. 129. <.5. +3 was 130. +6 was 111
5/27. 59. X. 142. >.50. +6 was 84
5/28. 178. .5. 241. 2.25. +2 was 184. . +6 was 197

During the time when his insulin was low he showed no symptoms of hypoglycemia, plus his diarrhea cleared up, his urine output was much better and he wasn't always screaming to eat. So when I saw the PPMS value of 241 tonight I went back to his regular dosage of 2.25...this probably was not a good idea. I just tested him at +2 and he was 140.

I feed him after his shots and at +6

Can someone please help me with his dosage. I really want to keep his numbers lower since I saw such an improvement with his bowel and hunger issues, however I realized that I really am new to this and should be asking for advice instead of trying to figure this out on my own.

I would really appreciate any advice,

Mary
 
Re: Newby-need help

Welcome to the board. There are many people here who can be a great help to you. Its great that you are testing at home, and you've done a good job of setting out the test numbers. I wasn't quite able to follow your dose changes. Lantus is a good gentle long acting insulin. It works best if it is given twice a day at 12 hours apart (I think that you are doing this) and the dose is held steady for a minimum of 3 days unless the cat goes too low. I think that you might be able to get more specific dosing advice in the Lantus ISG. If you haven't visited there, you might click on one of the Lantus groups and read the excellent documents at the top of the list - called stickies because they are always there. I don't use your insulin, but it looks to me like you are getting really good numbers. Again, I don't use your insulin, but it does look like 2.5 was a little too much for Schmitty. I'll see if I can alert a Lantus user to pop in here and take a look.
 
Re: Newby-need help

Thanks for your response. I just checked Schmitty's glucose and it was 75 at + 2.5. I'm afraid it's going to keep dropping tonight. Sorry my glucose numbers were hard to follow ... My spaces didn't work on the posting. I'm new to posting so I'm not sure how everything works.
 
Re: Newby-need help

Have you read the info on how to handle a hypo? Do you have some hi carb food in the house. I think that you may well need soem tonight. If you have some FF with gravy, I would give him a little now - maybe a teaspoon - and then test again in 20 minutes. You want to slow that drop. If you don't have FF with gravy, can you send someone out to get a few cans?
 
Re: Newby-need help

Hi there,

There are a bunch of sticky notes at the top of the Lantus TR forum that you should read when you have time. The one you might want to take a look at now is on how to handle low numbers http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

I haven't had many low numbers but hopefully someone who can help will be along soon. It's important to have lots of test strips, some high carb food/Karo or corn syrup ready just in case.
 
Re: Newby-need help

I just retested him and he was at 33... No signs of hypoglycemia but I put some honey on his gums and gave him some dry food my other cats eat. He ate a handful and looks good. When should I retest. Thanks for all who responded this late!
 
Re: Newby-need help

Hello, and welcome. First, can you please remove the candle from your post -- here it means a cat has gone to the Rainbow Bridge :sad:

Please clarify:

AMPS 343, shot 2U? +2. 339
+4. 240
+6. 175
+8. 235
+10. 277
PMPS 276, shot 2U?
+14. 254 (is this +4 or +14?)
AMPS 278
PMPS 182

You then increased to 2.25U for 2 days, and increased to 2.5U on the 3rd day. You did not shoot that evening due to low BG numbers.

5/26 AMPS=100, shot 0.5U?; PMPS=129, shot 0.5U?, +3=130, +6=111
5/27 AMPS=59, no shot?, PMPS=142, shot 0.5U?, +6=84
5/28 AMPS=178, shot 0.5U?, PMPS=241, shot 2.25U?, +2=184, +6=197 (but you also said +2 was 140 - which is it?)


The first thing you will hear is that Lantus needs consistency in dosing. Typically cats stick with a dose for 6 cycles (3 days) until a change is made, unless of course BG numbers are too low to shoot. It's interesting that his BGs were in the 200-300s on 2U, and then you wisely dropped to 0.5U and still got excellent numbers. Frankly I'd stick with 0.5U for a while. Were you doing anything different when you got those higher numbers on 2U?

I am not an expert on Lantus, but used a similar insulin (Levemir) on my Donovan. He never showed symptoms of hypo either! I am sure you will get more detailed responses in the morning, or perhaps there is a night-owl west coaster who will stop by. But based on the data I see so far, I don't think Schmitty needs 2U at this time.

MJ
 
Re: Newby-need help

:shock: oh my goodness. Dry kibble tends to take too long to kick in. Do you have any high carb food? Something with gravy (squish out the gravy and give it to him), or "grilled" Fancy Feast? If not, yes, putting karo syrup or honey on the gums will do. You want to re-test every 15-20 min until you see at least three rising or steady BG numbers above 50.

MJ
 
Re: Newby-need help

From the sticky I mentioned above, here are the guidelines for testing.
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of food with high carb (HC) gravy or HC food only. (If you have a cat with GI issues, using syrup plus LC food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.

DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
Click to expand...

Note that dry food takes longer to take effect. If you do not have high carb food, then you can put one or two drops of karo/corn syrup in his regular food.
 
Re: Newby-need help

Wendy & Neko, can you stick around for a while? I'm on the east coast and it's approaching 2 am, but I don't want to leave Mary and Schmitty alone here. I posted on the Lantus board looking for west coasters.

MJ
 
Re: Newby-need help

I'm popping over from Lantus Land. How many hours since you gave him insulin until you got the 33?

I'm glad you gave him honey on his gums but MJ is right...dry food takes way too long to kick in and then it hangs around a long time. Do you have any high carb canned food with gravy? We want to give a couple tsps of gravy, wait 30 mins and retest. Continue until he's In the 50s. You are going to have to stay on top of his numbers until he's up over 100.

Honey, karo, etc west off quickly and numbers can come back down on you. There is a link tomHandling Low Numbers in my signature block. Please print this off for future reference.

I need to check on someone in Lantus ISG and I'll be back looking for your next number, ok?

Thanks.
 
Re: Newby-need help

Just tested again and he was at 48. Went ahead and gave him some dry food with honey . Will retest and if it's still going up will feel much better. Thanks again. Tried to clean up my original post...hopefully tomorrow someone can tell me where to go from here.

I give morning shot at 9:30. I will test glucose before and post level so I can get advice on dosage.

Thanks, Mary
 
Re: Newby-need help

Mary

That 48 is the honey and it will wear off quickly. Lantus can give a 16 hour hypo.....this is not a trivial thing. Are you able to send someone out for HC canned food...one of the Fancy Feast grilled varieties with gravy? I am very concerned that just because he is coming up, you feel safer but please do not.

Can you let me know if you can get some canned food and also can you retest him 30 mins from the last test and give us a number? Also...please tell me how many hours after his shot that you got the 33?
 
Re: Newby-need help

Marjorie,

I gave his shot at 9:15 and got the 33-- 3 hours later. Tested 30 min later and got the 48(just now) Only other wet food I have is purina ur (other cat has urinary issues)

Right now Schmitty looks good...hates me pricking his ear so much...never works the first time! Will test again at 1:15

Thanks!
 
Re: Newby-need help

I'm here, just catching up on the post.

The Purina UR is 11% That would be good to give right now.

The honey works right away, but as Marje said, it usually wears off in an hour or 2. Dry food may tak a couple of hours to have an effect Lantus is a good insulin because it is a long lasting insulin. Unfortunately, that means if you cat goes low it will also take a long time to get past the danger.

Keep testing every half hour. Where are you, time zone? when you give us times we need to know the time zone. Thats why we always talk in + hours after the shot.
 
Re: Newby-need help

Mary

The way lantus works is it onsets between +2 and +3 depending on the cat. Then it progressively lowers the BG until the nadir which, again depending on the cat, is approximately +6. Which means tht best case scenario ( unless he bounces back up from liver reacting to low numbers), you could be working these numbers at least for 3 hours.

However, lantus is a depot insulin. Each shot builds upon the previous one and it builds a shed. When the shed gets full, numbers coming tumbling down...think of a bucket that fills and overflows. The shed from the higher dose you gave can affect up to six subsequent cycles!

I'm on the west coast so I can stay up until he's safely up. Is there any chance someone can run out for the food? I have no idea what %carbs the purina prescription diet is. I would assume it is to low carb.
 
Re: Newby-need help

I recall another cat that was given white bread soaked in warm milk with honey. Maybe Marjorie or Ann will have other hi carb ideas. If you are not able to send someone out for a gravy cat food, then some improvising will be needed. This isn't a panic situation, but certainly not one to be taken lightly. The problem is that honey gives a sugar spike that often results in a drop afterwards. Dry food takes a while for the carbs to be digested. The gravy cat foods seem to raise the blood sugar fairly quickly and hold it there - this is why we are asking about having someone else in the house go to the corner store for you.
 
Re: Newby-need help

thanks for jumping in, everyone -- Mary and Schmitty, you are in good hands.
Hope to see you over in the Lantus group soon.

night.
MJ
 
Re: Newby-need help

I just tested and he was at 46. Not sure if I should give him the canned ur or more honey. Plus he's eaten about 1/4 of dry food and I'm not sure when that takes effect. I'm in the central time zone so it's been 4 hous since shot. Also I can't leave house and get other food.

Someone said ur is 11%
 
Re: Newby-need help

I'd give him the purina with some honey. The honey will continue to bump him up faster but the 11% ur will stay in his system longer. Do you ave any vanilla ice cream? You can give him that as well.
 
Re: Newby-need help

Just gave him ur and honey. Luckily he was still hungry. I do have vanilla ice cream. Should I give that to him now or wait till next reading? It's really nice to know that there are people out there who take the time to help. I really appreciated it.
 
Re: Newby-need help

Leers see what he does with the ur and the honey. The ice cream also wears off fast but cats like it. See you in 30.
 
Re: Newby-need help

I just tested... About 40 min from last test. It was 49. Should I give any more food or honey. Not sure if he'll want to eat again .
 
Re: Newby-need help

How much honey are you giving him? He should be coming up by now but honey takes longer tha. Syrup/karo.

If he'll eat another tsp of food, I'd give him that with karo or syrup if you have it. If you don't, then give him 1/2 tsp honey. If he won't eat it, give him some vanilla ice cream.

Doing ok?
 
Re: Newby-need help

He ate the food with tsp of honey. I've been giving him about that much each time. I'm doing fine. I could kick myself for giving him the 2.25 shot. Today when his numbers went back up he also had diarrhea 3 times so I wanted to get his numbers down low again...obviously a mistake

I know you are probably tired. I will keep monitoring till numbers are on a steady rise. In an hour he will be at +6. I don't want you to have to stay up. I'll continue the same routine ;-)
 
Re: Newby-need help

Are you sure? I can nap in between your tests.

I want to be sure you keep testing/feeding every 30 mins until you get him up in the 80s. Then you can go to one hour and not feed to see if he stays up. you need two rising tests with no food before you can quit testing.

I'd like to see another test before I think about leaving you. I'd really like to see him up a lot more before I go to bed for the night. Can you test him pls and let me know? Thanks, Mary.
 
Re: Newby-need help

I just tested him and he was 61. I will feed again. I will get him close to 80 and then stop feeding and see what he does. I feel bad for his little ears! I'm good if you want to head off to bed! Thanks for all your help. Can you advise me on where I should post tomorrow for dosage help?

One thing...what if he won't eat?
 
Re: Newby-need help

Good...better! I would not give any more honey...just the food. It takes about two hours for the honey to wear off so just keep checking snd be sure he's continuing to rise after two hours from the last honey, ok?

If he turns around and comes back down below 40, put up the 911....if no one responds and you cannot get him up immediately, then get him to the ER ok? Hypos can and do kill....not to scare you but I want you to be extra cautious.

While you are staying up with him, if you could do a spreadsheet, it will really help people give you dosing advice. We normally don't advise on dose without one. Here is the link to doing a SS. spreadsheet

If you've been shooting .5u until tonight, it might be best to go back to that until you have a SS together and we can see where he is. We typically increase and decrease by .25u....not big jumps up and down. you can post in Health if you don't have a SS. We like you to at least have a SS when you come to the lantus TR Insulin Support Group. But that is the best place for a lantus user...many eyes and lots of learning going on there.

I hope he comes up and you get some rest. I'm worried about leaving you. It won't be too long before some of the east coasters will start signing on.
 
Re: Newby-need help

Just saw your question on what if he won't eat. Try putting Parmesan cheese or any treats on it that he likes. If he'll eat dry, let him. Give him vanilla ice cream. If none of that works and he's starting to drop, give him a big dose of honey with a syringe. You can always put up the 911. Hopefully, he'll eat the dry.
 
Re: Newby-need help

I got up early today, and I can be here to watch, guide, and support. You can go to bed, Marge. Thanks for staying up so long.
 
Re: Newby-need help

Thanks for your help. I feel ok with the info you gave me for tonight. Hopefully Schmitty's numbers are on the rise!
 
Re: Newby-need help

Mary, please keep posting Schmitty's test numbers. I'll be here for you, as I am up for the day.
 
Re: Newby-need help

That's the number you were hoping for.
Okay, I'll see you in an hour.
Schmitty is my dad's nickname :smile: .
 
Re: Newby-need help

Just tested and it was 150. I'm going back to bed! :smile: Any advice on dosage at 9:30? All my numbers are in my first post. Thanks,
 
Re: Newby-need help

Let me re-read your entire condo. You go back to bed. Set an alarm, so you don't oversleep.
Check back here, before you shoot.
 
Re: Newby-need help

Before you leave, are you going to be home to monitor him today?
 
Re: Newby-need help

I know you want to keep Schmitty in the lower range of numbers because he acts better and feels better in those numbers, but I think that 2 unit and 2.25 unit dose was too high. I think you should start over again with maybe 1.00 unit or maybe even 0.50 units. Sometimes, when a cat goes into really low numbers, they might be extra sensitive to insulin afterwards, and Schmitty has a shed (depot) built up from those 2 unit doses.
Schmitty may be high in the morning, but that is just his liver reacting and spilling extra glucose and counter regulatory hormones into his system. We call that a bounce. The bounce will clear. Sometimes bounces clear fast, sometimes they can take up to 72 hours to clear. You just have to be patient and wait it out.

I have asked for some other eyes to look in on your condo, and hopefully, you will get some more advice on this morning's dose, by the time you get up.

If you're going to be home to monitor Schmitty, today, I think you may be able to start over at 1.00 unit.
If you have to leave for work for the day and will not be home, then maybe he should be started over at 0.50 units.

Meanwhile, get your supplies together, today. Stock up on low carb canned food and high carb canned food, and make sure you have plenty of testing supplies.

I have to log off now, to get ready for work.

Hoping you get some quality sleep, and you and Schmitty have a good day.
 
Re: Newby-need help

Mary

Good morning....I'm so glad Scmitty came up last night....good job!

Weird...I posted last night that Dyana was going to take over for me and to let you know she is one of our most experienced in the lantus ISG but I don't see that post. Sorry...I also tell members that I'm helping if we are switching out helpers....I have no idea where that post went :lol:

If you haven't shot yet this morning, we'd like you to just shoot .5u okay? Then if you can get a spreadsheet done and head over to the lantus TR ISG we can take a hard look at the SS and see where to go from here.

I'm really happy he came up! Thanks for staying calm. :-D
 
Re: Newby-need help

Good morning. How is Schmitty this morning? Have you tested him this morning or given him a shot?
 
Re: Newby-need help

I just posted a new thread...wasn't sure who would check this one...he is at 259. I'm hoping to get advice on shot this morning. Thanks for checking :smile:
 
Re: Newby-need help

Marjorie

Just saw your post and gave him .5 cc ( I hope). My hands had that smell on it after a petted the injection site. I don't want to go crazy pricking his ear...when should I do the next test?

Off topic. Can I ask you a question about your job sometime?
My daughter is majoring in wildlife and fishery.

Thanks, Mary
 
Re: Newby-need help

Chippy said:
Marjorie

Just saw your post and gave him .5 cc ( I hope). My hands had that smell on it after a petted the injection site.
Click to expand...


Insulin is most commonly measured in units. 0.5 cc (or 0.5 ml) is the same as 50 units which is an OD for most cats :shock: Did you mean to say that you gave 1/2 a unit (0.5 units)?

Fur shots are common, especially for newbies. Do not give any more insulin if you do a fur shot because you have no way of knowing if some insulin actually got into the cat and you don't want to double dose the cat and risk a hypo a few hours later.
 
Re: Newby-need help

Mary...I'm glad you shot the .5u dose. Just to let you know, insulin is given in units not cc. A cc is the same as a ml. There are 100 units in one ml.

I'm assuming you are using U100 syringes right?

It would be good if you could get a +2 test. It would also be great if you could get the SS up and then hop over to Lantus TR with your +2 test. If you have any problems with the SS, send me a private message (click on the PM box under Gracie's photo) and I'll help you.

Yes....please feel free to ask me questions about my job...just send a PM. :-D
 
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